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New body to tackle health disparities

Following a government announcement, a new body set to tackle health disparities in the UK will launch on Friday 1 October.

The Office for Health Improvement and Disparities (OHID) aims to tackle health inequalities across the country and will be co-led by newly appointed Deputy Chief Medical Officer (DCMO), Dr Jeanelle de Gruchy.

The OHID will play a vital role in the Department of Health and Social Care, driving the prevention agenda throughout the government to minimise health disparities, many of which have been exacerbated by the pandemic, and improve the public’s health.

Unfortunately, health disparities around the UK are austere. For example, a woman living in Blackpool will on average live 16 fewer years in good health than a woman born in Brent, London.

The government is also aware that ethnicity can impact health and health outcomes.

Health disparities can consequently undermine a person’s ability to work and live a long, healthy and independent life, whilst putting pressure on the NHS, social care and other public services.

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Source: National Health Executive, 7 September 2021

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Why vaccinating all teens is a difficult decision

The UK's vaccine advisory body has decided not to recommend vaccines for healthy 12-15-year-olds, but it will offer vaccines to thousands more children with underlying health problems.

Ministers will now seek more advice on extending the rollout based on factors such as school disruption.

There is general agreement that this was a really tricky call to make. Bur The Joint Committee on Vaccination and Immunisation (JCVI) has focused squarely on the health benefits of vaccination to children themselves - not on the impact to their schooling or other people.

Children's risk from Covid isn't zero but the chances of them becoming seriously ill from Covid are incredibly small. Deaths among healthy children are extremely rare - most have life-limiting health conditions.

That means there needs to be a clear and obvious advantage to giving them a jab. However, a very rare side-effect of the Pfizer and Moderna vaccines has made that calculation a lot more complicated.

Paul Hunter, professor of medicine at University of East Anglia, says there's been intense pressure on the JCVI and he can understand why they are being cautious.

"I don't know what the answer is - I'm very close to the fence on this. There's not enough data to be absolutely certain."

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Source: BBC News, 4 September 2021

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Covid in Scotland: Can in-person GP appointments ever fully return?

Community doctors in Scotland have told the BBC they cannot imagine returning to normal face-to-face service with current levels of demand.

Allowing more patients to see their GP in person is a top priority for the government's NHS Recovery Plan. But as the country tries to emerge from the pandemic, surgeries are seeing unprecedented pressure to catch up with patients.

The health secretary has confirmed that new guidance should allow practices to see more people in person. But greater use of telephone and video appointments, brought in when the pandemic hit, is going to continue.

Dr Begg has been a GP for 25 years. He says they won't go back to business as usual, the way they worked before.

"In person consultations are really important, to examine people, to give injections, to remove lesions, all of these. I think a flexible approach is what we need. It's what we were planning to do before the pandemic anyway; a flexible mix of phone call, video and in-person consulting where it is appropriate."

Dr Begg says the new ways of working are essential to deal with the huge number of requests they get.

"There is a demand, capacity gap and indeed there was before the pandemic. We are seeing at last more students come through medical school and more people finally coming to join general practice training, but this is going to take at least ten years to turn things around."

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Source: BBC News, 7 September 2021

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Nurse shortage ‘delaying treatment for 21% of UK cancer patients’

More than 600,000 cancer patients in the UK are facing treatment delays or missing out on vital support because of a shortage of specialist nurses, a new report from Macmillan Cancer Support reveals.

One in five of all those living with cancer (21%) are lacking dedicated support. The NHS is suffering from a “shocking” shortfall of 3,000 specialist nurses in England alone, according to the analysis by Macmillan Cancer Support.

As a result, cancer patients are struggling with medication, having hospital appointments cancelled because there are not enough staff or experiencing devastating delays to chemotherapy. In some cases, patients are ending up in A&E.

Patricia Marquis, England director of the Royal College of Nursing, warned the workforce crisis was having a “devastating impact” on people living with cancer. “Expertise built up over many years is lost very quickly and it is patients who pay the price, as this report shows,” she added.

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Source: The Guardian, 8 September 2021

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Northern Ireland health system "one step from chaos"

"Bodies would have been piling up" if the Covid vaccine had not been available, the director of intensive care at Belfast City Hospital has said.

Dr George Gardiner, a consultant, also said his biggest fear would be having to stop routine cancer surgery. He has called for an end to "tribal politics" in Northern Ireland to allow transformation of the health service, so that cancer and coronavirus can be tackled in tandem.

He said the system was currently "one step from chaos" and warned hospitals will not cope with winter if Covid numbers continue to rise.

"We need to get everyone who can take a vaccine to take it now before the winter pressures are on us," Dr Gardiner added.

"The cancer surgery that we are doing at the minute is life saving. A few more Covid admissions, which could be prevented, will cause us to stop operating because we simply haven't got the capacity to do both."

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Source: BBC News, 7 September 2021

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Increased ambulance handover delays threatening patient safety

A new snapshot survey by the Royal College of Emergency Medicine has found that in August 2021 half of respondents stated that their Emergency Department had been forced to hold patients outside in ambulances every day, compared to just over a quarter in October 2020 and less than one-fifth in March 2020.

The survey, sent out to Emergency Department Clinical Leads across the UK, also found that half of respondents described how their Emergency Department had been forced to provide care for patients in corridors every day, while nearly three-quarters said their department was unable to maintain social distancing every day.

One-third said that the longest patient stay they had had in their Emergency Department was between 24 and 48 hours, with 7% reporting the longest stay to be more than 48 hours.

Dr Ian Higginson, Vice President of the Royal College of Emergency Medicine, said: “It is shocking to see the extent of the challenges faced by Emergency Departments across the UK. Holding ambulances, corridor care, long stays – these are all unconscionable practices that cause harm to patients. But the scale of the pressures right now leaves doctors and nurses no options. We are doing all we can to maintain flow, maximise infection prevention control measures, and maintain social distancing. Our priority is to keep patients safe, and ensure we deliver effective care quickly and efficiently, but it is extremely difficult right now."

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Source: The Royal College of Emergency Medicine, 6 September 2021

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Healthy baby terminated by hospital in mix-up with sick twin

Doctors at a hospital in Birmingham mistakenly terminated a healthy unborn baby in a procedure instead of its sickly twin.

The unidentified mother decided to abort one of the fetuses because it was suffering from restrictive growth, which increases the chances of stillbirth and puts the healthy baby at risk. During the procedure at Birmingham Women's and Children's NHS Foundation, surgeons accidentally terminated the wrong twin.

The 2019 incident emerged in a Freedom of Information Act survey of hospital blunders.

Dr Fiona Reynolds, chief medical officer at Birmingham Women's and Children's NHS Trust, said: "A full and comprehensive investigation was carried out swiftly after this tragic case and the findings were shared with the family, along with our sincere apologies and condolences."

"The outcome of that thorough review has led to a new protocol being developed to decrease the likelihood of such an incident happening again."

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Source: The Independent, 6 September 2021

 

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GP staff facing abuse from patients over cancelled blood tests

GP surgery staff are facing abuse from patients who are “angry and upset” that their blood test has been cancelled because of the NHS-wide chronic shortage of sample bottles.

“Patients are angry when we ring them up and say, ‘Sorry we can’t do your blood test after all’. A lot of people are quite angry and concerned about their own health,” Dr David Wrigley, the deputy chair of council at the British Medical Association, said.

“Patients are quite rightly upset and some get quite aggressive as well. They are worried because they don’t know what the implications of their cancelled test are for their health.”

GP practices in England had begun cancelling appointments because the NHS’s main supplier could not deliver stocks as planned for one to two weeks because of “unforeseen road freight challenges”. 

NHS England has responded to the shortage of blood sample bottles by telling GPs to cancel all but clinically urgent blood tests and hospitals to cut back the tests they do by at least 25%. 

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Source: The Guardian, 6 September 2021

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Hospital admits liability for baby’s death after ignoring mother’s concerns

A hospital has admitted liability for the death of a baby who was delivered stillborn three days after his mother’s complaints of fluid loss and severe pain were dismissed as wetting the bed.

Jacob Jackson could have been born healthy, Shrewsbury and Telford hospital trust (Sath) has accepted, if it had arranged an earlier delivery in October 2018 as his mother, Charlotte, had suggested.

The incident happened 18 months after an external review had been ordered into serious maternity failings at the trust, which are now known to be the biggest maternity scandal in the history of the NHS.

Charlotte said: “It makes me feel sick to my stomach that they knew there were problems – this sort of thing had been going on for decades. We keep getting fed the same lines that ‘lessons have been learned’. If lessons had been learned parents and babies wouldn’t be going through this.”

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Source: The Guardian, 6 September 2021

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What has caused the NHS blood tube shortage?

Becton Dickinson (BD), which manufactures most of the blood tubes used by the NHS, has alerted NHS England and NHS Improvement (NHSE/I) to a global shortage of some of its products, including two types of blood tubes: those with a yellow or purple top.

BD says that the COVID-19 pandemic created the most unpredictable demand it has seen in the past 70 years. The company says that it has also been difficult for customers to predict the types and quantities of blood tubes they will be using from month to month, which affects manufacturers’ abilities to meet demand. “Adding to the issue are global transportation delays that have resulted in more products being tied up in transportation than is normal, creating additional delays in deliveries,” BD said in a statement. “Raw material suppliers are also challenged to keep up with demand for materials and components.”

In the UK, BD has been authorised to import blood tubes that are approved for use in other regions of the world, including the United States. It plans to deliver nine million of these additional blood tubes to the NHS for immediate distribution. 

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Source: BMJ, 3 September 2021

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NHS gender identity clinic whistleblower wins damages

A child safeguarding expert who faced vilification after raising concerns about the safety of children undergoing treatment at a London NHS gender identity clinic has won an employment tribunal case against the hospital trust.

Sonia Appleby, 62, was awarded £20,000 after an employment tribunal ruled the NHS’s Tavistock and Portman trust’s treatment of her damaged her professional reputation and “prevented her from proper work on safeguarding”.

Appleby, an experienced psychoanalytical psychotherapist, was responsible for protecting children at risk from maltreatment.

The tribunal heard evidence she raised concerns about the treatment of increasing numbers of children being referred to the trust’s Gender Identity Development Service (Gids). The service in Hampstead has been at the heart of a controversy over its treatments, including the provision of drugs known as puberty blockers to children as young as 10.

The tribunal heard evidence that after she raised the concerns, instead of addressing them, the trust management ostracised her and attempted to prevent her from carrying out her safeguarding role, by sidelining her. Appleby said the management’s action amounted to a “full-blown organisational assault”.

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Source: The Guardian, 4 September 2021

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Hospital-acquired infection caused one-in-five covid deaths at several trusts

More than one in five ‘covid deaths’ were both probably hospital-acquired, and caused at least in part by the virus, at several trusts, according to analysis released to HSJ.

HSJ obtained figures from more than 30 trusts which have looked in detail at cases where patients died after definitely, or probably, catching covid in hospital. 

Thirty-two acute trusts provided HSJ with robust data, out of the total 120 in England. Across all 32, they had recorded 3,223 covid hospital deaths which were either “definitely” or ‘probably’ nosocomial — making up around 17% of their total reported 19,020 hospital deaths.

The trusts said 2,776 of the 3,223 deaths also had covid listed on their death certificate, either as an “immediate cause” or as a contributory factor. That constitutes about 15% of all the hospitals’ covid deaths, and 86% of the nosocomial deaths.

When approached by HSJ, these trusts said they followed robust infection control practices, and that high community covid prevalence, and covid admissions, were the main cause of hospital-acquired infection. Some trusts also cited their ageing infrastructure.

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Source: HSJ, 6 September 2021

 

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Coroners warned of mental health care failings in dozens of inquests

Shortfalls in mental health services and staffing have been flagged as concerns in dozens of inquests since 2015, the Observer has revealed, with coroners issuing repeated warnings over patients facing long waiting lists or falling through gaps in service provision.

The Observer has identified 56 mental health-related deaths in England and Wales from the start of 2015 to the end of 2020 where coroners identified a lack of staffing or service provision as a “matter of concern”, meaning they believed “there is a risk that future deaths could occur unless action is taken”.

Coroners issue Reports to Prevent Future Deaths (PFD) when they believe action should be taken to prevent deaths occurring in future, and send them to relevant individuals or organisations, who are expected to respond. In one case, a woman referred to psychotherapy services had still not received any psychotherapy by the time she died 11 months later. In another, someone had endured a seven-month wait for a psychological assessment.

Alison Cobb, senior policy and campaigns officer at the mental health charity Mind, said: “It’s shocking that so many should lose their lives because there isn’t enough capacity in mental health services to provide adequate care. These prevention of future deaths notices are meant to inform better ways of working, and it’s especially concerning that similar stories are repeating over and over again.”

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Source: The Guardian, 5 September 2021

Coroner's reports on the hub

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Top doctor’s family call for probe into ambulance delays on day he died of cardiac arrest

The family of a senior medic and lifelong NHS campaigner have called for an investigation into his death as it took paramedics more than half an hour to arrive at his home after operators were told he was suffering a cardiac arrest.

Professor Kailash Chand, a former British Medical Association deputy chair, had complained of chest pains before one of his neighbours, a consultant anaesthetist at Manchester Royal Infirmary, called 111 for help before telling the call handler within three minutes that he believed his friend was having a cardiac arrest.

“I was answering their questions when Kailash’s eyes began rolling and he slipped into unconsciousness. That’s when I said ‘this looks like a cardiac arrest’ and to upgrade the call. They kept asking questions as I started CPR and asked for an urgent ambulance. That was two or two and a half minutes into the call."

Evidence seen by i News shows that it took another 30 minutes after the neighbour told the operator about the cardiac arrest for the paramedics to arrive at Professor Chand’s flat in Didsbury, Greater Manchester.

National standards for ambulance trusts show that ambulance trusts must respond to category 1 calls – those that are classified as life-threatening and needing immediate intervention and/or resuscitation, such as cardiac or respiratory arrest – in 7 minutes on average, and respond to 90% of Category 1 calls in 15 minutes.

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Source: iNews, 3 September 2021

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Police raised multiple concerns to regulator about hospital

Police raised concerns to the Care Quality Commission over the care at a private hospital, run by Cygnet Health Care, after being called eight times by a patient, a report has revealed.

The CQC has now placed the hospital, which provides care for female patients with learning difficulties, in special measures and rated it inadequate.

The CQC report, published today, said: “Staff we spoke with said they were trained in how to use de-escalation techniques. However, two told us they were anxious as a team about using restraint. As a result, police were being regularly called to respond to incidents at the hospital by both staff and patients.”

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Source: HSJ, 02 September 2021

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Private ambulance firm deregistered by CQC

A private ambulance company, KFA Medical,  which provided patient transport services for the NHS has been deregistered by the Care Quality Commission over concerns for patient safety. Concerns included lack of basic training and Disclosure and Barring Service checks on employees were not up to date or had not been carried out and when looking at four staff files none had current basic life support training.

Sarah Dronsfield, the CQC’s head of hospital inspection, said: “We have been working with the provider since their suspension in January, however when we carried out this inspection, we found the provider had been unable to implement and sustain the necessary improvements to assure us that people were receiving safe care. This action should send a very clear message to all providers of independent health and care services that while taking enforcement action of this nature is not something we take lightly, we will always take action where appropriate to protect the health and safety of patients,” 

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Source: 03 September 2021

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There is no greater priority for the Royal College of Nursing than the safety, security and wellbeing of its members and staff.

The RCN has today launched a new independent and confidential help and support line for any members or staff who have been affected by the issues relating to the reports received.  

Pat Cullen, General Secretary and Chief Executive, said: "Anyone can be affected by sexual harassment. It’s not restricted to any gender, age, ethnicity, sexuality or role. If you have been affected, it is important that you are listened to, supported, and helped to work through any actions you wish to take. This 0800 number will allow members or staff to discuss any concerns about sexual harassment related to RCN activity. 

“All staff and members have a right to feel safe and we are taking all necessary steps to provide that security. We must tackle the issues and behaviours that have no place in our College. We must demand better, for members and for the profession.”  

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Source: RCN, 02 September 2021

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Covid: Schools aren't infection hubs, says public health boss

Public Health England's medical director has said schools are not "drivers" or "hubs" of Covid infection.

"We understand, and I understand fully, that parents may be nervous but I would stress again that schools are not the drivers and not the hubs of infection." Said Dr Yvonne Doyle.

However, Prof Calum Semple, a government scientific adviser, said with most adults vaccinated, schools were likely to be a "greater part of the problem"

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Source: BBC News, 02 September 2021

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National Insurance: Minister says social care must be properly funded amid tax hike claims

According to reports, the government plans to raise national insurance of at least 1% to help improve social care and tackle NHS backlog. Justice Secretary Robert Buckland has said the government must find a way for social care to be adequately funded. 

Labour has said the NHS and social care needed proper investment but it was wrong to raise national insurance, which would disproportionately affect people on low incomes, young people and businesses.

"Boris Johnson still hasn't come forward with the plan for social care he promised over two years ago, and instead they're proposing a manifesto-breaking tax rise that would hit working people and businesses hard," said shadow chief secretary to the Treasury Bridget Phillipson.

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Source: BBC News, 03 September 2021

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NHSE funding policy risks ‘levelling down’ maternity safety, warns hospital chief

 

Glen Burley, an acute trust chief executive has said NHS England risks ‘levelling down’ safety in some maternity services by ‘disproportionately’ directing additional funding to struggling trusts.

This comes after NHS England said the funding prioritised the trusts which needed the most support to meet the essential actions in the Ockenden Report, where in March, NHSE invited trusts to bid for a share of £96m extra funding for maternity services. 

A spokeswoman for NHS England has said: “The NHS made an additional £96m investment in maternity services following the Ockenden Review, the majority of which will bolster the workforce by funding an additional 1,200 midwives and 100 obstetricians. While the funding for additional workforce is for all NHS trusts, it is right that those who most need the support are prioritised.”

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Source: HSJ, 02 September 2021

 

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COVID-19: Children must return to 'normal pre-pandemic experience' in schools, education secretary says

Gavin Williamson, despite the risk of Covid, has insisted children must return to a "normal pre-pandemic" experience in schools. The education secretary said testing could be the key to guarding against infection rates, but refused to rule out a potential rise after experts have warned surges in Covid-19 are linked to classrooms. 

"This is why we're doing the testing programme and we're encouraging children to take part in it, parents, and of course teachers and support staff as well. This is a way of rooting out Covid. We're trying to strike that constant, sensible balance of actually giving children as normal experience in the classroom as possible, but also recognising we're still dealing with a global pandemic." He told Niall Paterson. 

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Source: Sky News, 02 September 2021

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Long Covid in children 'nowhere near scale feared'

Experts have said the risk of "long Covid" in children is much lower than many had feared, with research suggesting somewhere between 2% and 14% still had symptoms caused by Covid 15 weeks later.

However, while the research team found little evidence to showing huge number seeking help for symptoms that had left them bedridden or unable to attend school, it was still important that they received support if they had any persistent symptoms such as headaches, tiredness and breathing difficulties. 

Prof Sir Terence Stephenson, from UCL's Great Ormond Street Institute of Child Health, said of the development of Long Covid in children, "It is nowhere near what people thought in the worst-case scenario".

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Source: BBC News, 01 September 2021

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Warning over cuts to NHS services without £10bn extra funding

Groups representing the NHS have warned services may have to be cut unless NHS England receives an extra £10bn in funding next year, which may put patients at risk. 

The NHS Confederation and NHS Providers said the money was needed to cover pandemic-related costs and reduce the backlog in operations and treatments, but the government said it had already provided additional money to tackle backlogs.

"We are committed to making sure the NHS has everything it needs to continue providing excellent care to the public as we tackle the backlogs that have built up during the pandemic. This year alone we have already provided a further £29bn to support health and care services, including an extra £1bn to tackle the backlog. This is on top of our historic settlement for the NHS in 2018, which will see its budget rise by £33.9bn by 2023-24." Said a government statement. 

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Source: BBC News, 02 August 2021

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Large-scale GP group says its doctors routinely have ‘unsafe’ workload

The Modality Partnership, one of England's biggest general practice groups told HSJ that its GPs are regularly seeing more patients each day than is safe, after the number of people going to see their GP surged in the wake of Covid-19.

Data has shown the provider’s GPs had an average of 20 patient contacts per day during April 2020, which has now risen to to an average of nearly 50 patient contacts per day. Modality, which had drawn up a report on the situation were quoted as saying, "There is just so much to cover – I am worried about missing something.” 

One partner at Modality who is also quoted in the report said: “An increasing number of patients I see are broken, often in tears, and seeking help to cope with the new stresses of life.”

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Source: HSJ, 31 August 2021

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New Naloxone campaign tries to reduce deaths from drug overdoses

A new campaign to increase awareness of life-saving treatment that can reverse drug overdoses has been launched in Scotland.

The Scottish government and Scottish Drugs Forum (SDF) have joined together to help improve information about naloxone which can prevent deaths in the case of opioids overdoses.

Drugs policy minister Angela Constance said: “Firstly, on International Overdose Awareness Day I want to pass on my sincere condolences to all those who have been affected by a drug-related death. That is why I am pleased to launch this joint campaign with Scottish Drugs Forum to encourage the public to get involved in our national mission and equip themselves to save a life."

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Source: The Independent, 31 August 2021

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